I'm a clinical psychologist and psychoanalyst. For 20+ years I've been practicing on 12th Street, around the corner from the Forbes Building and right in the middle of the digital revolution — both of them. Having written for professional audiences and become a not infrequent source (e.g., Wired, New York, NY Times, The Today Show) I figured Web 2.0 was the right time to put my ideas out there myself. First at True/Slant, then Psychology Today, and now at Forbes, my "beat" includes clinical insights and research developments useful for building an authentically good life in our increasingly complex and technologically-mediated world, along with identifying those choices that promise more than they can deliver. Along with my full-time private practice I'm a Training and Supervising Psychoanalyst at the William Alanson White Institute and a Clinical Assistant Professor in Psychiatry at New York Medical College.

Is Brian Williams 'Addicted' to Addiction? Here's What You Really Need To Know About 'Internet Addiction'

So-called “Internet addiction” is back in the news. It’s not pretty. Consider a recent NBC Rock Center report from Brian Williams and chief medical editor Nancy Snyderman. It ended with both correspondents saying that when it comes to this new diagnosis they started off as skeptics but ended as “believers.” But in what? In what were they believing by report’s end? Furthermore, might that belief, rather than demonstrating a reasoned analysis that illuminates the problem, ironically show them to be “addicted” to addiction?

Those who follow “Managing Mental Wealth” know I’ve written about “Internet addiction” several times. So, let me say I’ve also just published an article for fellow professionals in theJournal of Clinical Psychology that investigates using the addiction-concept for understanding out-of-control Internet behavior. I argue you can’t solve new problems by relying only on old ideas, and that we need to better understand the new kinds of experiences people seek when immersed, for example, in online gaming. Only by knowing what people are actually doing online can we understand how things can go wrong.

Saying people “get addicted” risks killing curiosity with premature certainty. More specifically, believing that the diagnostic certainties of addiction can explain the very real, new, and quite perplexing problem of people getting trapped by online behaviors goes against current science and clinical experience. Neither current research nor clinical experience show that people who are in trouble online suffer from a behavioral addiction similar to, for example, gambling. [Here is an additional post for the science-minded showing how the research cited by NBC does NOT support an “Internet addiction” diagnosis, despite them claiming it does.]

If Mr. Williams’ and Dr. Snyderman’s new found belief was limited to the discovery that people really are struggling with pathological out-of-control Internet behavior then I would say, Bravo! Despite the skepticism of some, people are suffering: I’ve seen it in my practice; I hear about it from students and supervisees; when I present to professional audiences I hear more than a few horror stories; and, most important of all, there is good research documenting the problem. For example, a well-done 2009 nationwide survey of youths between 8 and 18 by Douglas Gentile of Iowa State University and the National Institute on Media and the Family found

“8.5% of video-game players exhibited pathological patterns of play as defined by exhibiting at least 6 out of 11 symptoms of damage to family, social, school, or psychological functioning.”

No question there is a problem that needs to be understood. But “addiction” is not currently the answer. So, the question becomes why do some become enthusiastic believers in addiction as the diagnostic explanation for the problem absent sufficient evidence? I think we need to consider two reasons.

First is the discomfort of not knowing. We like knowing what is going on, or at least feeling as though we know. When we don’t know, when we find ourselves in situations of perplexing uncertainty, we become anxiously uncomfortable, and anxiety undermines curiosity. Having a name—a diagnosis!—for something is soothing; it provides the feeling of knowing even when there is no knowledge to be had. A diagnosis can be seen as functioning like a cognitive painkiller to soothe the anxious-making uncertainty of not knowing: “Whew! Now we know!” And like those who overuse actual painkillers, Mr. Williams and Dr. Snyderman have overused diagnostic certainty to the point that we can say they have become “addicted” to addiction.

The second reason is the complexity of the term “addiction.” It means different things when used by patients than it means when used by a doctor.

When patients say they are addicted to doing something online they are communicating an experience, and a pretty awful one at that. They are saying they feel trapped by impulses and behaviors they can’t control, even when they also see themselves doing incredible damage to their lives. Sometimes it’s with gaming, other times online porn, and I’ve even seen others who have had trouble with dating and hook-up sites. When they say “I’m addicted,” they are saying they feel and act as out-of-control and self-destructive as do junkies with a needle or a crack-pipe. By stating they are an addict they clearly communicate the abject suffering and out-of-controlness of the experience.

But when a clinician uses the term it is meant as a diagnosis. It is an explanation for behaviors and experiences. It implies facts have been gathered and sorted in a particular way. It implies a body of research. And it suggests a particular cause, a prognosis, and recommended treatments.

Again, there is currently not enough data to establish that pathological Internet overuse should be diagnosed as a behavioral addiction, like, for example, a gambling addiction. Plus, clinical experience with patients who describe themselves as Internet addicts has been that they do not respond to treatment in the same way that, for example, alcoholics and substance-abusers do.

Might the problem be more like a compulsion than an addiction, more like compulsive hand-washing than alcoholism? Or maybe it comes from an impulse control disorder, or a problem with attention or judgement? Perhaps it is a symptom that can come from multiple problems? Or, as I have been arguing, might it be something new, a new problem emerging from the new experiences afforded by emerging technologies? Maybe it’s that people get confused, profoundly pathologically confused, and look to life on the screen for that which only life can fully provide. Maybe it’s that “screen relations” provide just enough life-likeness to keep alive the promise of having it all. Maybe, just maybe, pathological overusers are more like early moviegoers who fled theaters on first seeing moving images of a rapidly onrushing train than they are like drunks and junkies.

We need to keep the maybe alive because we don’t know. We need to keep curiosity alive, especially as technologies develop and emerge. We do not need journalists closing down the process of not knowing. What we do know is that NBC, Rock Center, Mr. Williams, and Dr. Snyderman did us all a disservice, especially those suffering from out-of-control Internet behaviors.

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The author appears to be ignorant of approximately 25 recent brain studies on Internet addiction – employing multiple neuroimaging and electrodiagnostic methods, control groups and valid assessment criteria. All studies showed the same brain changes as found in drug addicts. Two studies followed former addicts and both reversal of brain changes. I can cite all studies upon request.

The author appears ignorant of the specific brain changes caused by addiction. Why else would he say something so silly as to compare addictions to OCD. Thirty years, and thousands of animal and human studies, have established very specific set of brain changes caused by addiction. It is these brain changes that researchers found in the aforementioned 25 Internet addiction studies.

I would like Essig to explain how the compulsion to use X, differs from an addiction to X. Please be very specific: The specific circuits, neurotransmitter, receptors, transcription factors involved and how each is altered in addiction. I suggest a simple review: Is There a Common Molecular Pathway for Addiction? (2005) by Eric Nestler. In the 7 years since this review, all research has validated the model it established

It has been established that all addictions – both behavioral and chemical – are triggered by a single molecular switch – DeltaFosb, which turns on specific genes, leading very specific cellular changes.

Last year the American Society of Addiction Medicine (ASAM) clearly stated that exhibiting the signs, symptoms, and behaviors of an addiction indicates one has the corresponding brain changes. In other words, addiction is one condition, not a bunch of separate discrete entities with unique neurobiology. Years of research corroborates this statement. In addition, the upcoming DSM5 has established a behavioral addiction category.

I urge Forbes to consider the opinion of an addiction neuroscientist, rather than a psychoanalyst (Essig). It’s clear from Essigs earlier writings that he doesn’t believe in the concept of behavioral addictions, and has little understanding of addiction neurobiology.

Thanks for being an example of what I meant about the anxiety of uncertainty and how the diagnosis of “Internet addiction” is used to kill curiosity about what may really be going on.

It seems you are so certain about your beliefs that you didn’t even bother to read what I actually wrote. Specifically, I wrote above “Neither current research nor clinical experience show that people who are in trouble online suffer from a behavioral addiction similar to, for example, gambling.” Hhhmmm? I guess I am on the same page with current research when it comes to behavioral addictions like gambling. The problem is that there isn’t good research showing that this is the case with out-of-control Internet behaviors. If you are going to be snarky and critical at least get straight the basic facts of the position you are trying to ridicule. I am not arguing against behavioral addictions, that would be silly. I am arguing against prematurely believing out-of-control Internet behaviors are one.

Also, despite the certainty with which you cite my “ignorance” you have apparently not read other relevant things I wrote, even when I linked to them in the article above. Take a look at the piece I linked to above titled “Addiction Redefined by Medical Group.” In it I applaud ASAM for the way they defined addiction. Did you even bother to take a look at the companion piece in which I talked about problems with the methods used in the study NBC cited ? Here’s the link http://www.forbes.com/sites/toddessig/2012/11/15/heres-how-brian-williams-and-rock-center-got-the-science-of-so-called-internet-addiction-really-really-wrong/ Was this one of the 25 studies you mention? It was the one brain study cited in the NBC report. And, when you actually read the report it does not (NOT) support the explanatory power of addiction for Internet behaviors.

While we’re on the topic of those appr 25 recent brain studies you say support diagnosing out-of-control Internet behaviors as an addiction, I’m going to call your bluff. How about you post a citation (or a link if available) to the best, the absolute best, of those studies you mention. Don’t just dump a reference list. Post your best shot and we’ll take a close look at the study. Maybe it’s something I have not yet read. Regardless of who you may think I am I really would welcome good research.

You have yet to address my arguments. Your entire argument relies on outdated and refuted claims that a compulsion to use X must have different neural correlates than an addiction to X.

You have not answered THE one question that would end this discussion as to whether Internet addiction is an addiction or not. So I ask you again: Explain how a compulsion to use X differs from an addiction to X. Please be very specific, and cite neuroscience-based studies.

As stated by ASAM has provided its answer in its definition of addiction: all addictions involve the same mechanisms and changes, which are reflected in a well established list of sign, symptoms and behaviors.

For other readers’ information, renaming an addiction as a “compulsion” is the usual tactic employed by those arguing against behavioral addictions (to food, sex and Internet). It is a false dichotomy. Essig will not be able to compare and contrast the neural correlates of compulsion vs addiction. Todd Essig has:

• Ignored all anecdotal, clinical, and research evidence that points to Internet addiction as a true addiction.

• Ignored multiple brain studies on Internet addiction disorder.

• Stated that the signs, symptoms and behaviors of Internet addiction must arise from some unidentified mechanisms other than addiction.

• Replaced the word addiction with compulsion, yet provides no research or hypothesis on what makes a “compulsion to use X” different from “an addiction to X”.

• Ignored researchers and medical doctors of ASAM who provide the hard data of addiction neuroscience.

• Suggested that Internet addiction must be the one and only exception to the rule – an addiction that is somehow not an addiction.

ESSIG QUOTE: “Neither current nor clinical experience show that people who are in trouble online suffer from a behavioral addiction similar to, for example, gambling”

ESSIG QUOTE: “They are saying they feel trapped by impulses and behaviors they can’t control, even when they also see themselves doing incredible damage to their lives. Sometimes it’s with gaming, other times online porn, and I’ve even seen others who have had trouble with dating and hook-up sites. When they say “I’m addicted,” they are saying they feel and act as out-of-control and self-destructive as do junkies with a needle or a crack-pipe”

If the above isn’t “out of control behaviors” what is?

Anyway, the addiction field has well accepted criteria for all addictions, beginning with, “continued use despite negative consequences.” ASAM’s new definition of addiction provides specific criteria for ALL addictions. Alternatively, or one can use the well accepted 4 C’s of addiction: 1. Compulsion to use 2. Continued use in spite of adverse consequences 3. Inability to Control use 4. Craving – psychological or physical

On to your analysis of that single study. In simple terms, you are suggesting that the abnormal white matter was a pre-existing condition.

First, this is nothing more than an opinion, and we already know where you stand on Internet addiction.